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Meta-Analysis
. 2021 Dec:50:661-669.
doi: 10.1016/j.ajem.2021.09.050. Epub 2021 Sep 24.

Outcomes of atrial fibrillation in patients with COVID-19 pneumonia: A systematic review and meta-analysis

Ming-Yue Chen  1 , Fang-Ping Xiao  2 , Lin Kuai  1 , Hai-Bo Zhou  2 , Zhi-Qiang Jia  2 , Meng Liu  2 , Hao He  2 , Mei Hong  3
Affiliations
Meta-Analysis

Outcomes of atrial fibrillation in patients with COVID-19 pneumonia: A systematic review and meta-analysis

Ming-Yue Chen et al. Am J Emerg Med. 2021 Dec.

Abstract

Background: Recently, emerging evidence has suggested that atrial fibrillation (AF) has an epidemiological correlation with coronavirus disease 2019 (COVID-19). However, the clinical outcomes of AF in COVID-19 remain inconsistent and inconclusive. The aim of this study was to provide a comprehensive description of the impact of AF on the prognosis of patients with COVID-19 pneumonia.

Methods: Three electronic databases (PubMed, Embase, and Web of Science) were searched for eligible studies as of March 1, 2021. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were used to evaluate the associations between AF (preexisting and new-onset) and in-hospital mortality, post-discharge mortality, and ventilator use.

Results: A total of 36 individual studies were incorporated into our meta-analysis. The combined results revealed that preexisting AF was associated with increased in-hospital mortality (pooled OR: 2.07; 95% CI: 1.60-2.67; p < 0.001), post-discharge mortality (pooled OR: 2.69; 95% CI: 1.24-5.83; p < 0.05), and ventilator utilization (pooled OR: 4.53; 95% CI: 1.33-15.38; p < 0.05) in patients with COVID-19. In addition, our data demonstrated that new-onset AF during severe acute respiratory syndrome coronavirus 2 infection was significantly correlated with increased mortality (pooled OR: 2.38; 95% CI: 2.04-2.77; p < 0.001).

Conclusions: The presence of AF is correlated with adverse outcomes in patients with COVID-19 pneumonia, which deserves increased attention and should be managed appropriately to prevent adverse outcomes.

Keywords: Arrhythmia; Atrial fibrillation; COVID-19; Meta-analysis; Mortality.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of study selection process. Abbreviations: COVID-19: coronavirus disease 2019; ORs: odds ratios; 95% CIs: 95% confidence intervals.
Fig. 2
Fig. 2
Meta-analysis of the association between preexisting atrial fibrillation and in-hospital mortality in COVID-19 pneumonia. Results are presented as pooled ORs with 95% CIs. Abbreviations: OR: odds ratio; 95% CI: 95% confidence interval.
Fig. 3
Fig. 3
Sensitivity analysis of the relationship between preexisting atrial fibrillation and in-hospital mortality in COVID-19 pneumonia.
Fig. 4
Fig. 4
Meta-analysis of the association between preexisting atrial fibrillation and post-discharge mortality in COVID-19 pneumonia. Results are presented as pooled ORs with 95% CIs. Abbreviations: OR: odds ratio; 95% CI: 95% confidence interval.
Fig. 5
Fig. 5
Meta-analysis of the association between preexisting atrial fibrillation and ventilator use in COVID-19 pneumonia. Results are presented as pooled ORs with 95% CIs. Abbreviations: OR: odds ratio; 95% CI: 95% confidence interval.
Fig. 6
Fig. 6
Meta-analysis of the association between new-onset atrial fibrillation and mortality (including in-hospital and post-discharge mortality) in COVID-19 pneumonia. Results are presented as pooled ORs with 95% CIs. Abbreviations: OR: odds ratio; 95% CI: 95% confidence interval.
Supplementary Fig. 1
Supplementary Fig. 1
Egger's publication bias plot for in-hospital mortality.
Supplementary Fig. 2
Supplementary Fig. 2
Filled funnel plots for publication bias test of in-hospital mortality.
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